A 71-year-old man comes to the emergency department due to several episodes of bright red blood per rectum. His recent colonoscopy revealed numerous colonic diverticula. Laboratory studies on admission are notable for a hemoglobin of 8.2 g/dL with an unremarkable coagulation profile. An abdominal angiogram shows active bleeding from the sigmoid colon. Catheter embolization is planned via the femoral artery. During the procedure, the arterial catheter is most likely to proceed in which of the following orders?

Question

A 71-year-old man comes to the emergency department due to several episodes of bright red blood per rectum.  His recent colonoscopy revealed numerous colonic diverticula.  Laboratory studies on admission are notable for a hemoglobin of 8.2 g/dL with an unremarkable coagulation profile.  An abdominal angiogram shows active bleeding from the sigmoid colon.  Catheter embolization is planned via the femoral artery.  During the procedure, the arterial catheter is most likely to proceed in which of the following orders?

Quizplus · Accepted Answer

11ec160b_3580_fe5d_9249_1f83c27c116e_MD0001_00 In this patient with recurrent gastrointestinal bleeding, arterial embolization (mechanical occlusion of the artery using coils or absorbable substances) is planned to stop the active bleeding originating from his sigmoid colon. The distal one-third of the transverse colon, descending colon, sigmoid colon, and rectum are all hindgut derivatives. Hindgut structures receive blood from the inferior mesenteric artery (IMA), a branch of the aorta. These structures are drained by the inferior mesenteric vein (IMV), which does not course with the IMA. The IMV drains blood from the hindgut into the splenic vein, which drains into the portal vein. (Choice A) The celiac trunk supplies blood to most foregut structures from the lower esophagus to the second part of the duodenum. Foregut derivatives include the liver, pancreas, and gallbladder. The celiac trunk also supplies the spleen. (Choice C) The superior mesenteric artery supplies blood to the midgut, which spans from the third part of the duodenum to the proximal two-thirds of the transverse colon. (Choices D and E) The internal iliac artery supplies portions of the gut through branches such as the inferior rectal artery (a branch of the internal pudendal artery, which arises from the internal iliac artery) and the middle rectal artery (arises from the internal iliac). The internal pudendal artery supplies blood to the external genitalia. The superior rectal artery is a continuation of the IMA. Educational objective: The hindgut encompasses the distal one-third of the transverse colon, the descending colon, the sigmoid colon, and the rectum. These structures receive their main arterial blood supply from the inferior mesenteric artery.

A 71-Year-Old Man Comes to the Emergency Department Due to Several